Improving Sustainment through Implementation Supports to Reduce Burnout in Therapists Delivering Child Trauma EBPs

项目总结/摘要 许多基于证据的心理健康干预措施已经开发出来，以解决负面结果 与儿童早期遭受逆境和创伤有关。然而，尽管有这些有希望的进展， 在公共资助的精神卫生系统中服务的大多数儿童没有得到基于证据的 程序（EBP）。为了解决这一研究与实践之间的差距， 在过去的十年中，已经启动了多创伤EBP的实施工作，包括在 加州和阿肯色州。尽管这些系统驱动的计划通常会增加EBP的交付， 在社区环境中，在最初的实施推动之后，EBP交付的长期可持续性很低。 劳动力风险因素，如供应商倦怠导致营业额，已被确定为有助于 创伤EBP的长期维持性较差。因此，在支持长期- 长期维持儿童创伤EBP是制定实施战略，目标是提供者倦怠 以及与供应商保留率下降相关的组织气候因素。 这个拟议的K23指导以患者为导向的研究职业发展奖将开发和试点 一整套执行战略，"支持提供者和防止过度使用资源， 创伤系统"（创伤系统），旨在通过解决 与倦怠相关的提供者保留相关的因素。将向开发人员通报 通过对涉及多个EBP实施工作的计划进行的需求评估， 加州和阿肯色州。该项目将建立在申请人的研究和临床基础上， 经验，同时还提供对申请人未来发展至关重要的专业培训。具体地说， 申请人需要额外的培训：1）实施科学的理论和实践，特别是 强调组织管理和科学，因为它涉及到开发和测试， （2）先进的方法，包括定性和混合定性和 定量方法; 3）评估实施影响的医疗经济技术 战略布局该培训将由申请人的主要赞助商劳伦博士提供指导 布鲁克曼-弗雷齐和她的共同赞助人格雷戈里·亚伦斯博士、托德·吉尔默博士、丽莎·凯丝博士和艾莉森·汉密尔顿博士。 该项目将提供试点数据，以激励随后的NIMH R01应用进行大规模试验 支持维持儿童创伤循证护理的实施战略。此外，该项目将 为申请人提供开展独立研究所需的高级培训和技能 该计划的重点是改善对早期遭受逆境和创伤的儿童的心理保健服务。

PROJECT SUMMARY/ABSTRACT Many evidence-based mental health interventions have been developed to address the negative outcomes associated with child exposure to early adversity and trauma. Despite these promising advances, however, the majority of children served in publicly funded mental health systems do not receive evidence-based programs (EBPs). To address this research-to-practice gap, several large-scale, system-driven implementation efforts of multiple trauma EBPs have been launched over the last decade, including in the states of California and Arkansas. Though these system-driven initiatives often increase EBP delivery in community settings following the initial implementation push, long-term sustainment of EBP delivery is low. Workforce risk factors, such as provider burnout leading to turnover, have been identified as contributing to the poor long-term sustainment of trauma EBPs. Therefore, an important step to consider in supporting the long- term sustainment of child trauma EBPs is to develop implementation strategies that target provider burnout and organizational climate factors associated with decreased provider retention. This proposed K23 Mentored Patient-Oriented Research Career Development Award will develop and pilot a package of implementation strategies, “Supporting Providers & Preventing the Overwhelming of Resources in Trauma Systems” (SUPPORTS), aimed increasing the sustained delivery of trauma EBPs by addressing the factors associated with provider retention related to burnout. The development of SUPPORTS will be informed by a needs assessment conducted with programs involved with the multiple-EBP implementation efforts in California and Arkansas. This project will build upon the applicant’s foundation of research and clinical experience while also providing specialized training critical for the applicant’s future development. Specifically, the applicant requires additional training in: 1) theory and practice in implementation science with particular emphasis on organizational management and science as it pertains to the development and testing of implementation strategies; 2) advanced methodologies, including qualitative and mixed qualitative and quantitative methods; and 3) healthcare economic techniques to evaluate the impact of implementation strategies. This training will be facilitated by mentorship from the applicant’s primary sponsor, Dr. Lauren Brookman-Frazee, and her co-sponsors, Drs. Gregory Aarons, Todd Gilmer, Lisa Kath, and Allison Hamilton. This project will provide pilot data to motivate a subsequent NIMH R01 application to conduct a large-scale trial of the implementation strategies supporting the sustainment of child trauma EBPs. In addition, this project will provide the applicant with the advanced training and skills required to launch an independent research program focused on improving mental healthcare services for children exposed to early adversity and trauma.